Healthcare Provider Details

I. General information

NPI: 1083698658
Provider Name (Legal Business Name): BRADFORD W BUEGE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 E MAIN ST
WESTFIELD NY
14787-1104
US

IV. Provider business mailing address

189 E MAIN ST
WESTFIELD NY
14787-1104
US

V. Phone/Fax

Practice location:
  • Phone: 716-793-2203
  • Fax: 716-326-3811
Mailing address:
  • Phone: 716-793-2203
  • Fax: 716-326-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number271874
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: